Intralesional cyclosporine in the treatment of psoriasis. A clinical, immunologic, and pharmacokinetic study.
In a double-blind, vehicle-controlled study, all of six psoriatic plaques treated with intralesional cyclosporine administered three times weekly for 4 weeks showed complete clearing or incomplete but significant clearing in comparison with vehicle-treated plaques (p less than 0.01). Epidermal thickness decreased from 0.42 +/- 0.07 to 0.27 +/- 0.08 mm at 4 weeks (p less than 0.03). Biopsy specimens obtained on day 5, before any clinical improvement, revealed a significant reduction of epidermal DR+CD1- antigen-presenting cells, epidermal and dermal monocytes, and keratinocyte intercellular adhesion molecule-1 expression. By day 5 the stratum corneum reverted to normal in the plaques receiving cyclosporine. Pain at the injection site was the major side effect. Steady-state blood cyclosporine levels ranged from 20 to 30 ng/ml during the first 12 hours after injection and became undetectable at 48 hours. These data suggest that cyclosporine improves the skin of patients with psoriasis by a local mechanism of action.
Ho
V C
VC
Department of Dermatology, University of Michigan Medical Center, Ann Arbor 48109-0314.
Griffiths
C E
CE
Ellis
C N
CN
Gupta
A K
AK
McCuaig
C C
CC
Nickoloff
B J
BJ
Cooper
K D
KD
Hamilton
T A
TA
Voorhees
J J
JJ
D000328:Adult; D000938:Antigen-Presenting Cells / Q000473:pathology; D015815:Cell Adhesion Molecules / Q000032:analysis; D003524:Cyclosporins / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D004311:Double-Blind Method; D004817:Epidermis / Q000473:pathology; D006801:Humans; D015552:Injections, Intralesional; D007801:Langerhans Cells / Q000473:pathology; D014677:Pharmaceutical Vehicles; D010919:Placebos; D011565:Psoriasis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D011897:Random Allocation; D013601:T-Lymphocytes / Q000473:pathology; D013997:Time Factors
D015815:Cell Adhesion Molecules; D003524:Cyclosporins; D014677:Pharmaceutical Vehicles; D010919:Placebos